Insurance Clerk Medical Billing
Resume:
Toni M. Glover, CPC
Daphne, Alabama 36526
Cell: 251-***-****
Home: 251-***-****
adp0fa@r.postjobfree.com
Career Summery:
To obtain employment as an advancing certified medical coding professional in a challenging environment. Where I can continue to develop my professional talents and utilize my Coding expertise. Along with my PC proficient in all Microsoft Office programs, Excel, Data entry, Customer service to help the organization become more efficient and more profitable. I am an autonomous, team player who is self-motivated, able to act as liaison and a quick study. I am a highly professional, highly motivated customer service driven individual who thrives in environments where I am required to think carefully and thoughtfully about the brand I represent. I have been trained by the best to be the best and only produce the best. I am results oriented and understand the importance of keeping the big picture in mind to help the organization become more efficient and more profitable.
Summary of Skills:
Compassionate and empathetic medical personnel with strong analytical and communication skills.
Team player with exceptional organizational and problem-solving skills.
Able to work independently and effectively in a secure, home office, environment with a dual monitor setup.
Sound knowledge of ICD-9 and ICD-10, CPT and HCPCS codes for various diagnostics, treatment procedures, and medicines.
Fully knowledgeable in medical terminologies and coding systems.
Capable of creating accurate claims to present to the patient's insurance company for collecting payment within time limitations.
Adept in maintaining confidentiality of the patient data and entering accurate clinical codes in the software by using excellent research skills with the full understanding of how to classify provider documentation to assure the appropriate evaluation and management levels are assigned using the correct CPT codes, NCCI edits and LCD’s.
Expertise in operating hospital's software, (EHR) Software Electronic Health Records, Clinical database, and other computer applications such as Spreadsheet’s Medical Software, One Chart, Cerner e-HIM, athenahealth, Allscripts, CareCloud Software, TPX Solutions, Ingenious Med, DocuTap, 10-Key, Online Claim Submission, HCC Coder, and Cisco Jabber.
Well versed in EncoderPro-Expert with the EncoderPro-Plus, and The AMA CPT Content Module with CPT Asst CPT Changes Software Coding Program, as well as The EncoderPro-Expert HCC component software.
Work Experience:
Remote MedDRA Coder Temporary Contract
Insight Global/VAERS
March 15, 2021 – May 30, 2021
Review VAERS reports containing medical adverse events and applies MedDRA codes to classify the event.
Performs clinical data coding for information contained in the adverse event description, lab test, and medical conditions within the coding tool using MedDRA terms
Ensures that the selected codes accurately reflect the term as provided by the reporter at the Low-Level Term (LLT).
Contribute to the development of training manuals, coding guides and SOPs
Train other team members in MedDRA coding practices and assist other team members resolve complex issues, provide feedback to help improve quality of coding data
Participates in quality control processes and auditing procedures
Collaborate with other units to provide support for daily operations
Remote HCC Coder – Temporary Contract
The CSI Companies/Optum - UnitedHealth Group
August 26, 2019 – September 30, 2019
Review medical records and decipher if they are accurate and complete, accurate and in support of patient risk adjustment score accuracy
Ability to analyze medical records charts to identify ICD-10-CM codes with HCC or RxHCC value for appropriate coding compliance
Examined diagnosis codes for accuracy, completeness, specificity, and appropriateness according to services rendered.
Well-versed in developing, implementing, and maintaining tools for improved accuracy of coding and documentation
Oversee medical records and correct incomplete or incorrect codes for both active and previous conditions
Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information
Certified Professional Coder
Providence Health System (Ascension)Hospital, Mobile, AL
October 2015 – November 2018
Demonstrated knowledge and accurately assign ICD-10- CM codes, sequencing diagnosis per patient medical record for physician billing to the highest specificity ensuring that diagnostic codes and documentation accurately reflect and support the visit encounter.
Accurately assign ICD-10-CM, CPT and HCPCS codes and modifiers per patient medical record for physician billing for Colorectal Surgeon, General Surgeons specialists, Wound Care coding, Podiatrists, Endocrinologists, and Gastroenterologists.
Reviewing patients' medical reports for other clinical activity data to ensure complete and accurate coding, in the data to receive proper reimbursement
Coordinate and review all patient accounts to ensure proper billing-coding following medical guidelines and compliance rules
Coordinating with the team to perform data entry tasks to maintain accurate medical information, including doctor's name, surgery dates or other procedures, prescription, and discharge date in the hospital's database
Performing specific tasks related to accurate storage for ensuring accurate data quality, and completeness of clinical records
Maintaining an up-to-date database of clinical records in the hospital's software by coding diagnosis, treatment provided and prescriptions about drugs/injections.
Certified Professional Coder
MedPoint Medical Services, Inc., Mobile, AL
May 2015 – October 2015
Reviewed patient charts for submission to insurance companies, verifying thoroughness of records before processing or transmission, for multiple clinics throughout the state of Michigan.
Inspected the documentation on each chart, surveyed the patient information provided by the treating physician, and assigned all applicable ICD-10-CM, CPT and HCPCS codes and modifiers.
Abided by all medical practice procedures and processes to ensure full and complete accuracy.
Certified Professional Coder
Medical Alliance Group/Greater Mobile Urgent Care, Mobile, AL
April 2013 – April 2015
Reviewed and assigned accurate medical codes for diagnoses, procedures, and services performed by physicians, physicians’ assistants, nurses, and other qualified health care providers, at four (4) clinics in the Greater Mobile, Alabama area.
Performed various record review duties involving tasks related to coding ICD-10-CM, and surgical procedure CPT codes.
Assisted in the completion of timely and independent reviews of operative reports and physician notes to accurately assign CPT or ICD-10-CM codes to define the services provided.
Communicated with the applicable physicians and their staff when the patient's medical file was unclear and or incomplete.
Helped the team to maintain confidentiality of data such as coding diagnosis, treatment provided, and information about physicians who administered the treatment.
Coordinated with the team to analyze physician documentation contained in routine outpatient records for coding principal diagnosis and treatment procedures.
Ensured that the claims for the patient's visit at the clinic were properly coded and accurately billed to reflect the provided services to get appropriate payment from concerned patient's insurance company.
Carried out various clerical duties as required and entered charges into the designated billing systems for proper maintenance of records.
Remote Medical Biller and Certified Professional Coder
Modern Healthcare, New Orleans, LA
October 2005 – March 2013
Worked remotely and independently in a secure home office environment with a dual monitor setup.
Coded and billed claim submissions for sales and rentals of durable medical equipment, home medical supplies and hospice care services to Medicare, Medicaid, and private insurers.
Assisted in maintaining proper patient care data involving routine, respite, and in-patient hospice care services via working within the interdisciplinary group team of physicians, physicians’ assistants, nurse practitioners, nurses, pharmacists, social workers, physical therapists, clergy, and volunteers.
Assigned proper diagnosis information to each patient chart and evaluated as to coverage issues for durable medical equipment, home medical supplies, and hospice care services.
Retail Sales Associates
AT&T Wireless, Foley, AL
August 2002 – February 2005
Responsible for all sales and customer care for commercial and individual clients. Presented telecommunications services, plans and equipment to both new and existing customers in the Foley, Alabama store.
Increased market share by 20% via increasing average sales to walk in customers, as well as via telemarketing to existing customers.
Account Business Sales Executive
ALLTEL Communications, Mobile, AL
Aug. 2000 to May 2002
Responsible for all outside sales, customer care, and marketing of telecommunications plans and equipment in the Mobile and Baldwin County, Alabama markets.
Handling both the Individual and Commercial clients for increasing market share for the new potential clients and re-assessing the existing clients accounts ensuring that they have the updated proper telecommunication plans.
Increased market shares by 30% via aggressive cold calling and telemarketing.
Co-Owner/Manager
Tobacco Jack’s Retail Store, Foley, AL
October 1998 – August 2000
Responsible for all start up aspects including, incorporation, conducting all state and federal filings, obtaining all tax ID numbers and licenses (liquor, tobacco, occupancy) for this family owned and operated convenience store.
Established contracts for dozens of distributors and conducted purchases of merchandise.
Interviewed, hired and supervised all employees (temporary, full time, nights and weekends).
Compiled all accounting and tax data and aided CPA with monthly, quarterly, and annual filings.
Account Business Sales Executive
Bellsouth Mobility, Daphne, AL
April 1997 – October 1998
Continuously provided customer service, and ongoing re-evaluation of customer needs, to insure proper telecommunication plans for all existing clients.
Responsible for all outside sales, customer care, and marketing of telecommunications plans and equipment in the Mobile and Baldwin County, Alabama markets.
Handling both the Individual and Commercial clients for increasing market share for the new potential clients and re-assessing the existing clients accounts ensuring that they have the updated proper telecommunication plans
Increased market share by 30% via aggressive cold calling and telemarketing.
Advertising Account Executive
The Berry Company/Bellsouth, The Real Yellow Pages, New Orleans, LA
March 1993 – April 1997
Coordinated advertising for highly diversified business accounts.
Assessed customers’ needs while developing and presenting viable, profit producing advertising programs.
Responsible for sales and management of over 1,000 accounts per annum.
Real Estate Property Manager
Pontchartrain Place Condominiums, New Orleans, LA
September 1991 – March 1993
Managed 93 units at a $30,000,000 upscale, waterfront, development and participated in the preparation of annual budgets, accounts payable and receivable as well was conducted owners’ association meetings.
Coordinated all rentals and leasing for short term, long term, residential and corporate activities.
Education
Remington College, Mobile, AL. Campus
Diploma in Medical Billing & Coding, Medical Terminology/Human Anatomy and Physiology
Perfect Attendance
Fairhope High School – Graduated with Diploma
Professional Certifications
CPC Certified Professional Coder with AAPC
AAPC American Academy Professional Coders
OSHA Blood Borne Pathogens in the Workplace
HIPAA The Health Insurance Portability and Accountability Act of 1999
References
Dr. Joseph E. Bornstein, MD, MBA
Colon & Rectal Surgeon
Providence Medical Group
6701 Airport Blvd. Suite A208
Mobile, Alabama 36608
Bryna Thornhill
Providence Medical Group-Surgical Services, Manager
6701 Airport Blvd, #B-329
Mobile, AL 36608
251-***-**** – Contact Text Message and she will call you back.
Michael Bielaus
Modern Healthcare/Owner
Old Hammond Hwy, Suite 314
New Orleans, LA 70005
601-***-**** - Cell
601-***-**** - Office
Chevoyn Rudolph
Providence Hospital, Insurance Clerk
6701 Airport Blvd. Suite D143
Mobile, AL 36608
251-***-**** - Contact Text Message and she will call you back.
Michele Allen-May, MSM, RHIT, CPC, CPOC, CGSC
Sacred Heart Health System & Ascension/Providence Hospital
Supervisor Coding & Compliance Officer
5607 Woodbine Road
Milton, FL 32571
Monica Barrois
Bellsouth The Real Yellow Pages, The Berry Company
23314 Wellington Court Blvd.
Sales Manger
Spring, TX 73389
John Hyland
AT&T Wireless
Sales Manger
Foley, AL
Contact this candidate